Medicine In The Civil War

The Growth of Medicine in the American Civil War The Civil War brought change to American medical care due to troubles soldiers faced on the battlefield. The camps and battlefields were ridden with, poor sanitation, tight quarters, and many contagious and infectious diseases for which there was no immunization. 200,000 soldiers died of battle injuries, however, diseases such as dysentery, typhoid fever, small pox, and malaria, made up ⅔ of the casualties in the war. (Dixon). In addition, there was no way to transport the sick and the wounded, and with poor surgical techniques many lost their lives. “The organization of medical care when the war began was centered on the role of individual physicians rather than systems of care designed to
handle mass casualties. Both armies were shocked at the high casualty rates and unprepared for the management of these casualties.” (Tooker).
Furthermore, first aid was provided on the field or in regimental hospitals where the quality of care was poor because of unsanitary conditions and incompetent surgeons who lacked accreditation. (Paciorek). These harsh conditions as well as lack of preparation and knowledge triggered the implementation of better medical care. Medical advances made out of necessity in the Civil War prompted more effective medical practices, the legacy of which can be seen today. Even though injuries and casualties were expected, neither side was prepared to deal with them nor had much knowledge to treat them until later in the war. The poor preparation of the war was evident in the beginning when both armies struggled to efficiently tend to and transport their wounded, inadvertently sacrificing more lives to mere disorganization. (Dixon). At the beginning of the conflict, physicians had never treated a gunshot wound, and few were experienced in evaluating and treating the injuries of war. Although the physicians lacked training, the methods and procedures used were in many ways considered to be substandard. Uneducated physicians were not the
only rough condition that faced soldiers on the battlefield, for disease was the number one killer. The diseases that plagued the battlefield were dysentery, typhoid fever, ague, yellow fever, malaria, scurvy, pneumonia, tuberculosis, and smallpox, however, there was little knowledge and no known treatment of the diseases. Thus, on a densely populated battlefield with no preparations made, treating and identifying diseases was near impossible. In addition to these diseases, gangrene and infection were common with wounded soldiers. (Civil War Preservation Trust). The soldiers injured in battle were treated in unsanitary environments that were highly populated. This is because of, “for medical practitioners in the field during the Civil War, germ theory, clean medical practices, advanced equipment, and organized hospitalization systems were virtually unknown.”. (Dixon). In response to these poor conditions, the U.S. government created the U.S. Sanitary Commission, which preached the importance of clean water, healthy food, and fresh air. (Floyd). The U.S Sanitary Commission created a nursing corp which set standards for how to care for wounds and how to keep contagious diseases from spreading. (Floyd). The Civil War presented harsh conditions to Union and Confederate soldiers whose endurements and sacrifices led to the betterment of medicine. Despite the horridness of the Civil War, through experience and practice, physicians developed better surgical procedures and treatments for wounds.
The injuries in battle were brutal and painful, leaving soldiers with open wounds that would most likely become infected. The cause of these wounds was from artillery like minie balls (a 58 caliber slug) that caused the bones to splinter and shatter. The wound was often fatal if in the head, chest, or abdomen, while if in the extremities it usually required surgery. (Paciorek). The means to treating a soldier injured on the battlefield followed a system. When a soldier was wounded in battle he would make his way back to the field/regimental infirmary, or it would be up to the medical personnel to carry him back by litter (a stretcher). In the regimental hospital, the initial treatment was to stop bleeding, splint broken bones, and administer pain relievers. Treatments to stop bleeding consisted of lint and tourniquets, while pain relievers consisted of alcohol and chloroform. (Paciorek). Following these questionable treatments, a surgeon would decide if the wound was treatable, which if it was, surgery was the course of action. These surgeons gained knowledge and experience through constant practice leading them to make integral discoveries. “Due to the enormous number of wounded, the Civil War Surgeons became proficient at performing amputations. In many cases the amputation would be performed in 10 minutes. Surgeons, along
with their assistants, would work round the clock, ending up with stacks of amputated limbs up to five feet high.” (“Civil War Medicine” source #3). Several surgical procedures and medical practices evolved during the war to manage these critical injuries better. One of the most widely known and frightening of these practices was amputation. It was a primitive and brutal practice, but it was also a life-saving measure for many soldiers would have died from infection if the amputation of their injured limbs had been delayed. “Surgeons preferred simple circular amputation where the tissues were divided with circular incisions at a slightly higher level in each tissue layer. This left a cuff of tissue to provide coverage of the bone without closing the end of the stump as would be done with a flap amputation. (This "circular" technique is still the procedure of choice on the modern battlefield.)” (Wheat). Another major advancement noted out of the observation that survival rates were much higher in amputation done within the first twenty-four hour period. This is known as primary amputation. Secondary amputation is amputation after the first twenty-four hours. (Civil War Era Medicine). The system of primary and secondary amputation remains a part of modern health care. Despite the devastating injuries in the war, many surgical procedures and ways of treatment can be attributed to the soldiers that gave their lives. Specific advances in transportation were established to manage the horrific injuries soldiers suffered on the battlefield. Managing and treating the immense number of casualties on the battlefield created a large problem. The solution was the implementation of a “three-tiered hospital system”, which resembles the triage system today. (Paciorek). When a soldier was wounded in battle, he would be taken to a field/regimental hospital where a surgeon would decide if the wound was fatal or treatable. If the wound was treatable, it would be classified as a minor injury in which the soldier could be treated and remain attached to his regiment, or it would be classified as a major injury in which the soldier would be transported to a larger hospital for further care. (Wheat). This hospital system created a structured layout that would manage the immense numbers of casualties and get them better treatment in shorter time. The hospital system allowed for better hospitals to be constructed, such as large well-ventilated hospitals, which improved sanitation and prevented the spread of disease. Alongside the “three-tiered hospital system” came the creation of emergency services in 1862. The early ambulance system had many problems, such as having to go over rough terrain, sending the patients bouncing all over and ripping open fresh surgical wounds, or being in short supply of ambulances. There were few ambulances that were present during the war, which is illustrated by the commands: “The division will move at midnight in the following order: First, Second, and Third Brigades. Half the ammunition and half the ambulance trains will accompany the division; one hospital and one medicine wagons for each brigade”. (War of the Rebellion). Despite these setbacks, over the next year the ambulances were reconfigured and made more efficient and more comfortable. Still, the ambulance system is one of the most integral components of emergency services today. (Paciorek). The system of ambulances benefitted the medical transportation and three-tiered hospital system; It allowed soldiers to get better care in a faster manner. The innovation of emergency service and transfer to move injured soldiers to appropriate levels of medical care can be seen as the beginning of ambulance service and emergency medical care and the coordination of triage services we view as the standard of care in hospitals today.
Many medical practices today can be traced to the Civil War and the efforts of doctors and nurses to manage the devastating effects of war-time conditions and soldiers’ injuries. The Civil War remains one of the bloodiest conflicts in American history. Even generations after the war, many people hold powerful sentiments about this terrible time in American history. Despite the loss of life and limb, the Civil War forced both Confederate and Union forces to develop medical care for the massive casualties they experienced. As a result, a new understanding of medical disease management, strategies to transport and treat mass casualties, and rudimentary systems of health care service were created. The legacy of those innovations are still part of theAmerican medical practice today. It is a tragic irony that the roots of modern health care developed in response to one of our nation’s most brutal internal conflicts.